Expandable attachment device and method

ABSTRACT

An attachment device with a radially expandable section is disclosed. The attachment device can have helical threads, for example, to facilitate screwing the attachment device into a bone. Methods of using the same are also disclosed. The attachment device can be positioned to radially expand the expandable section in cancellous bone substantially surrounded by cortical bone.

CROSS-REFERENCE TO RELATED APPLICATIONS

The application is a continuation of PCT Application No.PCT/US2008/003421, filed Mar. 12, 2008, which claims priority to U.S.Provisional Application No. 60/906,791, filed Mar. 12, 2007, both ofwhich are incorporated by reference herein in their entireties.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to a device and method forattaching to bones.

2. Description of Related Art

Broken bones, such as compression fractures of one or more vertebrae inthe spine, may be treated with internal fixation. Any indication neededspinal stability can also be treated by internal fixation. Examplesinclude scoliosis, kyphosis, spondylothisthesis and rotation, segmentalinstability, such as disc degeneration and fracture caused by diseaseand trauma and congenital defects, and degeneration caused by tumors.

As shown by FIG. 1, internal fixation in the spine is often accomplishedby first screwing fixation screws into the pedicles and vertebral bodiesof the vertebrae 10. FIG. 2 shows that the fixation screws are thentypically attached to a rigid fixation rod or plate that provide supportbetween one or more weakened vertebra 10. This support often immobilizesthe vertebra 10 to which the fixation screws have been inserted.

FIG. 3 illustrates that existing fixation systems often have thefixation rod 14 or plate 220, through which a number of fixation screws12 are deployed. The screw head 18 prevents the fixation rod 14 fromseparating from the fixation screw 12. The fixation screw 12 also has ascrew body 16 which has a screw longitudinal axis 20 often staticrelative to the fixation rod 14.

FIG. 4 illustrates that in some existing fixation systems, the fixationscrews 12 can be polyaxial screws: attached to the fixation rod 14 orplate 220 in a manner so that the screw longitudinal axis 20 can rotate,as shown by arrows, with respect to the fixation rod 14.

Backing out or loosening of the fixation screws 12 can cause a reductionof the fixation, up to complete failure or even resulting in additionalcomplications.

Furthermore, the bones are often weak and under heavy loads, the bonescan fail and the fixation screws 12 can be ripped from the boneresulting in complete failure and additional damage to the bone.

Therefore, a fixation screw that can substantially eliminate the risk ofbackout, and can provide a higher anchoring force is desired. A fixationscrew that can also minimize bone failure is desired.

SUMMARY OF THE INVENTION

An expandable attachment device and methods for using the same aredisclosed. The expandable attachment device can have a radiallyexpandable section and a distal end. The distal end can be configured tobe attached to a separate device, such as a fixation rod or plate. Thedevice can have an unexpandable section.

Also disclosed is an expandable attachment device that can have aradially expandable section and an unexpandable section. Theunexpandable section and/or the radially expandable section can haveexternal threads.

The devices described herein can be used as substitutes for fixationscrews in existing fixation systems. The devices can be used to treatbroken bones, scoliosis, kyphosis, spondylothisthesis and rotation,segmental instability, such as disc degeneration and fracture caused bydisease and trauma and congenital defects, and degeneration caused bytumors.

The devices can be configured to be used in systems with fixed screwlongitudinal axis or polyaxial configurations.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a partially see-through top view of a vertebra with fixationscrews therethrough.

FIG. 2 is a partially see-through lateral view of a section of the spinewith fixation screws and a fixation rod.

FIGS. 3 and 4 illustrate simplified variations of existing fixationsystems.

FIG. 5 illustrates a variation of the expandable attachment device in aradially contracted configuration.

FIG. 6 illustrates the variation of the expandable attachment device ina radially expanded configuration.

FIG. 7 illustrates a variation of the expandable attachment device in aradially contracted configuration.

FIGS. 8 and 9 illustrate a variation of the expandable attachment deviceand a method for radially expanding the device.

FIGS. 10 and 11 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIGS. 12 and 13 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIGS. 14 and 15 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIGS. 16 and 17 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIG. 18 illustrates a variation of the expandable attachment device in acontracted configuration.

FIGS. 19 and 20 illustrate variations of the expandable attachmentdevice of FIG. 18 and methods for radially expanding the device.

FIG. 21 illustrates a variation of the expandable section in a radiallycontracted configuration.

FIG. 22 illustrates the expandable section of FIG. 21 in a radiallyexpanded configuration.

FIG. 23 illustrates a variation of the expandable section in a radiallycontracted configuration on the expandable attachment device.

FIG. 24 illustrates a variation of the expandable section in a radiallyexpanded configuration on the expandable attachment device.

FIG. 25 a through FIG. 25 e illustrate variations of the expandablesection.

FIGS. 26 and 27 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIGS. 28 and 29 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIGS. 30 and 31 illustrate variations of the expandable attachmentdevice.

FIGS. 32 and 33 are side and end perspective views, respectively, of avariation of the expandable attachment device.

FIG. 34 is a side view of a variation of the expandable attachmentdevice.

FIGS. 35 a and 35 b illustrate a variation of the expandable section.

FIG. 36 is a side view of the expandable section of FIGS. 35 a and 35 b.

FIG. 37 is a variation of a close-up view of section A-A of FIG. 36.

FIG. 38 is a flattened view of a variation of the expandable section.

FIG. 39 is a variation of a close-up view of section B-B of FIG. 38.

FIGS. 40 a and 40 b are flattened views of variations of the expandablesection.

FIG. 41 illustrates a variation of the unexpandable section integralwith the central shaft and distal end of the expandable attachmentdevice.

FIG. 42 illustrates a variation of cross-section C-C of FIG. 41.

FIG. 43 illustrates a variation of cross-section D-D of FIG. 41.

FIG. 44 is a variation of a close-up E-E of FIG. 42.

FIG. 45 is a distal end view of a variation of the unexpandable sectionintegral with the central shaft and distal end of the expandableattachment device of FIG. 41.

FIG. 46 illustrates a variation of the center shaft integral with theunexpandable section and the distal end.

FIGS. 47 a and 47 b are various perspective views of a variation of thedistal end cap.

FIG. 48 is a side view of a variation of the distal end cap.

FIG. 49 is a distal end view of a variation of the distal end cap.

FIG. 50 illustrates a variation of cross-section Z-Z of FIG. 47 a.

FIG. 51 illustrates a variation of cross-section Y-Y of FIG. 47 b.

FIG. 52 illustrates a variation of the expandable attachment deviceattached to a variation of the deployment tool.

FIGS. 53 and 54 illustrate a variation of the expandable attachmentdevice in unassembled and assemble configurations, respectively, and amethod for assembling the expandable attachment device.

FIG. 55 illustrates a variation of the deployment tool in an unassembledconfiguration.

FIG. 56 is a close-up perspective view of the end of the deployment toolin an assembled configuration.

FIG. 57 illustrate variations of the expandable attachment device inradially expanded configurations, and measurements thereof.

FIGS. 58 and 59 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIGS. 60 and 61 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIG. 62 illustrates a variation of the expandable attachment device anda method for radially expanding the device.

FIGS. 63 and 64 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIG. 65 illustrates a variation of cross-section F-F of FIG. 64.

FIG. 66 is a perspective view of a variation of the expandable sectionin a radially contracted configuration.

FIG. 67 is an end view of the variation of the expandable section ofFIG. 66 in a radially contracted configuration.

FIG. 68 is an end view of the variation of the expandable section ofFIG. 66 in a radially expanded configuration.

FIGS. 69 and 70 are perspective views of variations of the expandablesection.

FIG. 71 illustrates a variation of the expandable section with thedeployment rod.

FIGS. 72 and 73 illustrate variations of cross-section W-W of FIG. 71.

FIGS. 74 and 75 illustrate variations of cross-section W-W of FIG. 72.

FIGS. 76 and 77 illustrate a variation of the expandable section of FIG.70 with a wedge, and a method for using the same.

FIG. 78 illustrates a variation of cross-section V-V of FIG. 77.

FIGS. 79 a, 79 b, 79 c, and 79 d illustrate perspective, top, side, andrear views of a variation of the manipulation tool.

FIGS. 80 through 82 illustrate a variation of the expandable section anda method for radially expanding the same.

FIGS. 83 and 84 illustrate variations of the expandable section.

FIGS. 85 and 86 illustrate various perspective views of a variation ofthe expandable attachment device in a radially contracted configuration.

FIG. 87 illustrates a variation of cross-section G-G of FIG. 86.

FIGS. 88 and 89 illustrate various perspective views of the variation ofthe expandable attachment device of FIGS. 85 through 87 in a radiallyexpanded configuration.

FIGS. 90 and 91 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIGS. 92 and 93 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIG. 94 illustrates a variation of the expandable attachment device anda method for radially expanding the device.

FIGS. 95 and 96 illustrate proximal end views of variations of theexpandable attachment device.

FIGS. 97 and 98 illustrate a variation of a the expandable section inradially contracted and expanded configurations, respectively.

FIGS. 99 and 100 are side and proximal end views, respectively, of avariation of the expandable section with the center shaft.

FIGS. 101 and 102 are side and proximal end views, respectively, of avariation of the expandable section.

FIGS. 103 and 104 are front and side perspective views, respectively, ofa variation of the expandable element.

FIGS. 105 through 107 illustrate variations of the expandable element.

FIGS. 108 and 109 illustrate a variation of the expandable section anddistal end and a method for radially expanding the device.

FIGS. 110 and 111 illustrate variations of the expandable section.

FIGS. 112 and 113 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIG. 114 illustrates a variation of the expandable element of FIGS. 112and 113.

FIG. 115 illustrates a variation of cross-section K-K of FIG. 114.

FIGS. 116 and 117 illustrate cross-sections H-H and J-J, respectively,of FIGS. 112 and 113, respectively.

FIGS. 118 and 119 illustrate a variation of the expandable attachmentdevice and a method for radially expanding the device.

FIG. 120 a illustrates a variation of multiple expandable elements.

FIG. 120 b is an end view of a variation of the expandable section in acontracted configuration.

FIG. 120 c is an end view of a variation of the expandable section in aradially expanded configuration and a method for radially expanding theexpandable section.

FIGS. 121, 122, 123 and 124 are side, perspective, distal end, andproximal end views, respectively, of a variation of the expandableattachment device in a radially contracted configuration.

FIGS. 125, 126, and 127 are distal end, proximal end, and side views,respectively, of a variation of the expandable attachment device ofFIGS. 121 through 124 in a radially expanded configuration.

FIGS. 128 and 129 are front and perspective views, respectively, of avariation of the expandable section in a radially contractedconfiguration.

FIGS. 130 and 131 are front and perspective views, respectively, of thevariation of the expandable section of FIGS. 128 and 129 in a radiallyexpanded configuration.

FIGS. 132 and 133 are front and perspective views, respectively, of thevariation of the expandable section of FIGS. 128 and 129 in a radiallyexpanded configuration.

FIGS. 134 and 135 are perspective and side views, respectively, of avariation of the center shaft.

FIG. 136 is an end view of a variation of the expandable section in aradially contracted configuration.

FIG. 137 is an end view of the expandable section of FIG. 136 in aradially expanded configuration.

FIG. 138 is a perspective view of the first expandable element and thesecond expandable element of FIG. 137.

FIG. 139 is a perspective view of the expandable section of FIG. 137.

FIGS. 140 through 142 illustrate variations of the expandable section inradially contracted configurations.

FIG. 143 illustrates a variation of the expandable attachment devicewith the expandable section of FIG. 141.

FIG. 144 illustrates an unassembled expandable attachment device of FIG.143.

FIG. 145 illustrates a variation of cross-section L-L of FIG. 143 duringuse.

FIG. 146 illustrates a variation of the expandable attachment device.

FIGS. 147, 148 and 149 illustrate variations of the expandableattachment device with the expandable section of FIGS. 140, 141 and 142,respectively.

FIGS. 150 and 151 illustrate side and perspective views, respectively,of a variation of the expandable section in a radially contractedconfiguration.

FIGS. 152 and 153 illustrate variations of the expandable section inradially expanded configurations.

FIG. 154 is a lateral view of the spine.

FIG. 155 illustrates cross-section M-M of FIG. 154.

FIG. 156 illustrates cross-section M-M of FIG. 154 with an expandableattachment device delivered into the pedicle and/or vertebral body.

FIG. 157 is a partial see-through lateral view of the spine with avariation of the expandable attachment device delivered to, and radiallyexpanded in, the pedicle and/or vertebral body.

FIG. 158 illustrates cross-section M-M of FIG. 157.

FIG. 159 illustrates a variation of a method for using a variation ofthe expandable attachment device to treat a broken bone.

FIG. 160 illustrates a variation of a method for using two variations ofthe expandable attachment devices to treat a broken bone.

FIGS. 161 and 162 illustrate a variation of a method for attaching anend attachment to the remainder of a variation of the expandableattachment device.

FIG. 163 illustrates a variation of method for using a variation of theexpandable attachment devices with a fixation rod in the spine.

FIG. 164 illustrates a variation of a method for using a variation ofthe expandable attachment devices with end attachments in the spine.

FIGS. 165 through 167 illustrate a variation of a method for expandingfirst and second expandable sections on a variation of the expandableattachment device.

FIGS. 168 and 169 illustrate variations of methods for using a variationof the expandable support device in the spine.

FIG. 170 is an anterior view of a variation of a method for using theexpandable attachment device in a spine with a fixation plate.

FIGS. 171 and 172 are sagittal cross-sections of a variation of a methodfor using the expandable attachment device in a spine with a fixationplate.

FIG. 173 illustrates a variation of the deployment tool.

FIGS. 174 through 178 illustrate a variation of a method for implantinga variation of the expandable attachment device for use as a toothanchor.

FIGS. 179 and 180 illustrate a variation of a method for implanting avariation of the expandable attachment device for use as a tooth anchor.

FIG. 181 illustrates a variation of the expandable attachment device.

FIG. 182 is a close-up view of the expandable attachment device of FIG.181.

FIG. 183 illustrates cross-section S-S of the expandable attachmentdevice of FIG. 181.

FIG. 184 illustrates a variation of close-up section T-T of theexpandable attachment device of FIG. 183

FIG. 185 is a close-up view of a variation of the expandable attachmentdevice.

FIG. 186 is an expanded view of the expandable attachment device of FIG.185.

FIG. 187 illustrates a variation of cross-section U-U of FIG. 186.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 5 illustrates that the expandable attachment device 22 can have anunexpandable section 28 at a proximal end, an expandable section 24 at amedial length along the expandable attachment device 22, and a distalend 34. In other variations of the expandable attachment device, theunexpandable section 28 can be distal to the expandable section 24,and/or the expandable attachment device 22 can have more than oneexpandable section 24 and/or unexpandable section 28 that can beinterspersed with each other.

The expandable attachment device 22 can have an expandable attachmentdevice axis 26. The expandable device axis 26 can be substantiallystraight or curved.

The proximal end of the expandable attachment device can have a tip 32.The tip 32 can be sharpened or otherwise configured to seat theexpandable attachment device in bone (e.g., having cutting teeth). Theunexpandable section 28 can have unexpandable thread 30, for example,configured to screw the expandable attachment device 22 into bone.

FIG. 5 shows that the expandable attachment device 22 can have aradially contracted configuration. FIG. 6 illustrates that theexpandable attachment device 22 can have a radially expandedconfiguration. For example, the expandable section can be radiallyexpanded, as shown by arrows.

The expandable section 24 can be resiliently and/or deformablyexpandable. The expandable sections 24 can be radially expanded by axialcompression (e.g., see FIGS. 8-11), rotation (e.g., see FIGS. 26-29),use of a lever such as a wedge, ramp or jack (e.g., see FIGS. 58-64), orcombinations thereof.

The expandable section 24 can be biased to resiliently radially expand.For example, the expandable section 24 can be self-expandable orreleasable spring. The expandable section 24 can be resiliently radiallyexpandable and can be additionally deformably radially expandable to alarger radius than achieved by resilient expansion alone.

The expandable section 24 can have one or more anchors extendingradially therefrom when the expandable section is in the radiallyexpanded configuration. The anchors can be brads, hooks, pins, teeth,fasteners, pegs, screws, skewers, spikes, stakes, or combinationsthereof.

FIG. 7 illustrates that the expandable attachment device axis 26 can becurved. The expandable attachment device axis 26 can have curved andstraight lengths. For example, the expandable attachment device axis 26can have a substantially straight length along the unexpandable section28 and the distal end 34, and a curved length along the expandablesection 24.

FIGS. 8 and 9 illustrates that the expandable attachment device 22 canbe radially expanded by applying a proximally-directed force to thedistal end 34 as shown by arrows of FIG. 8. The proximally-directedforce can be substantially parallel to the expandable attachment deviceaxis 26. The proximal force can be opposed by a distal force applied,for example, by the bone and/or a deployment tool. The expandablesection can then radially expand, as shown by arrows in FIG. 9.

FIGS. 10 and 11 illustrate that the expandable attachment device 22 canhave expandable thread 66 on the expandable section and unexpandablethread 30 on the unexpandable section. The expandable thread canradially expand with the remainder of the expandable section. Theexpandable attachment device shown in FIGS. 10 and 11 can be radiallyexpanded by the method as shown in FIGS. 8 and 9.

FIGS. 12 and 13 illustrate that the expandable attachment device can beradially expanded by applying a distally-directed force to the distalend as shown by arrow. The distally-directed force can be substantiallyparallel to the expandable attachment device axis. The distal force canbe opposed by a proximal force applied, for example, by the bone and/ora deployment tool. The expandable section can then radially expand, asshown by arrows in FIG. 13.

FIGS. 14 and 15 illustrate that the expandable attachment device canhave expandable thread on the expandable section and unexpandable threadon the unexpandable section. The expandable thread can radially expandwith the remainder of the expandable section. The expandable attachmentdevice shown in FIGS. 14 and 15 can be radially expanded by the methodas shown in FIGS. 12 and 13.

FIG. 16 illustrate that substantially the entire length of theexpandable attachment device can be the expandable section. The distalend can extend distally from the expandable section. FIG. 17 illustratesthat the entire expandable section can radially expand. FIGS. 16 and 17illustrate that the expandable section can have expandable thread. FIGS.18 and 19 illustrate the variation of the expandable attachment deviceof FIGS. 16 and 17, respectively, without expandable thread.

FIG. 20 illustrates that the expandable attachment device can have, fromdistal to proximal, a first expandable section, a third expandablesection, and a second expandable section. The first, second and thirdexpandable sections can radially expand at different rates (e.g., underdifferent deployment loads, for example one or more are resiliently andone or more are deformably expandable). For example, the first andsecond expandable sections can radially expand at the same rate, and thethird expandable section can radially expand at a lesser rate.

FIG. 21 illustrates that the expandable section 24 can have a number ofstruts 38 attached to each other at joints 40. When the expandablesection 24 is in a radially contracted configuration, the struts 38 canbe configured to form diamond-shaped ports 42. The expandable section 24can have a distal hoop 36 b at the distal end and/or a proximal hoop 36a at the proximal end. The hoops 36 can attach to all of the struts 38at the respective end. The hoops 36 and struts 38 can all be integralwith and/or attached to each other.

FIG. 22 illustrates that longitudinal compressive force 44 can beapplied to the expandable section, for example resulting in radialexpansion 46. In a radially expanded configuration, the struts candeform near the joints. The hoops can remain substantially static.

FIGS. 23 and 24 illustrates that the expandable section can be radiallyexpanded by longitudinally compressing the expandable section. Forexample, the deployment tool 60 (or expandable attachment device 22) canhave an anvil 142 and a deployment cap 47. The anvil 142 can be thedistal end and/or the unexpandable section. The deployment cap 47 can bepart of or attached to the unexpandable section and/or the distal end,for example, the opposite of the anvil 142. The expandable section canbe compressed between the anvil 142 and the deployment cap 47.

The deployment tool 60 (or expandable attachment device 22) can have adeployment rod 128, for example to transmit the compressive force to thedeployment cap 47. The deployment rod 128 can be releasably attached tothe deployment cap 47, for example via a releasable deployment anchor49. The releasable deployment achor can be released and the deploymentrod can be removed after the expandable section is radially expanded.

FIGS. 25 a-e illustrate variations of the expandable section's strut,port and joint configuration. FIG. 25 a illustrates that the ports canbe larger near a central region 54 near the longitudinal median of theexpandable section than in end regions 52. The lengths of the expandablesection with larger ports can radially expand during longitudinalcompression before the lengths of the expandable section with smallerports. The expandable section can have thread 50 and/or anotherreleasable attachment configuration at one or both ends. The expandablesection can have a tool port 48 configured to receive a deployment tool(e.g., a deployment rod) through the proximal end of the expandablesection.

FIG. 25 b illustrates that the struts and ports can be substantiallyidentical along the entire length of the expandable section. FIG. 25 ccan have main struts 56 and smaller folded cross-struts 58 that attachto multiple main struts 56. FIG. 25 d illustrates that the struts andports can be substantially identical along the entire length of theexpandable section and that the ports can be longer in the longitudinaldirection that in the angular direction, with respect to the expandablesection. FIG. 25 e that the struts and ports can be substantiallyidentical along the entire length of the expandable section and that theports can be longer in the longitudinal direction that in the angulardirection, with respect to the expandable section, and smaller and morenumerous than as shown in FIG. 25 d.

FIGS. 26 and 27 illustrate that when the distal end and/or expandablesection is rotated, as shown by arrow in FIG. 26, that the expandablesection can radially expand, as shown by arrows in FIG. 27. FIGS. 26 and27 illustrate that the expandable section can be distal to theunexpandable section.

FIGS. 28 and 29 illustrate that when the distal end and/or expandablesection is rotated, as shown by arrow in FIG. 28, that the expandablesection can radially expand, as shown by arrows in FIG. 29. FIGS. 28 and29 illustrate that the unexpandable section can be distal to theexpandable section.

FIG. 30 illustrates that the expandable section can have a slot 62radially through the expandable section. The slot 62 can have a helicalconfiguration along the expandable section. The distal end can bethreaded. The expandable attachment device can be detachably attached toa deployment tool 60.

FIG. 31 illustrates that the expandable section can have a texturedsurface. The expandable attachment device can have a distal end cap 64at the distal end. The distal end cap can have a substantially sphericalconfiguration.

FIG. 32 illustrates that the expandable section can have a helical slot62 and an expandable thread 66. The expandable thread 66 can be helicalat substantially the opposite angle of the helical slot 62. Theexpandable thread can be helical at a positive or negative angle withrespect to a plane perpendicular to the expandable attachment deviceaxis. The helical slot can be helical at the opposite-signed (i.e.,positive or negative) angle to the expandable thread.

FIG. 32 illustrates that the distal end of the distal end cap can havecap deployment tool attachments 68, for example cross-notches on thehead of the cap 64. The cross-notches can be utilized to engage thedistal end cap 64 with an engagement tool.

The distal end of the center shaft can have a shaft deployment toolattachment 70, for example, an allen or hexagonal or septagonal socket.

FIG. 34 illustrates that when the expandable section is in a radiallycontracted configuration, the expandable thread 66 can protrude to aboutthe same radius at the unexpandable thread with respect to theexpandable attachment device axis.

FIGS. 35 a and 35 illustrate that the expandable section can be separateto the remainder of the expandable attachment device. FIG. 35 billustrates that the helical slot can extend through the thickness ofthe wall of the expandable section. FIGS. 36 through 39 illustrateadditional details of the expandable section.

FIG. 38 illustrates that the expandable section can have an expandablesection wall 72 can have numerous helical slots in a slotted wallsection 74. The expandable section wall can have one or more unslottedwall sections 76, for example at the distal and proximal ends of theexpandable section. The slots can have joints at one both ends of theslots.

FIG. 39 illustrates that the joints can be circular. The joints can havea larger, smaller or equal diameter to the width of the slot.

FIG. 40 illustrates that the expandable section wall can have one ormore retrograde slot sections 76, for example at each end of the slottedwall section 74. The retrograde slot section 76 can have slots 62 in thesubstantially opposite direction of the slots 62 in the remainder of theslotted wall section 74. The primary (i.e., non-retrograde) slots can behelical at a positive or negative angle with respect to a planeperpendicular to the expandable attachment device axis. The retrogradeslots can be helical at the opposite-signed (i.e., positive or negative)angle to the primary slots.

The retrograde slot section 76 can, for example, act as a shockabsorber. The retrograde slot section 76 can increase maximum radialexpansion of the expandable section. The slots 62 can be sinusoidalalong the length of the expandable section.

FIG. 40 b illustrates that the ends of the slots 62 can be placed atdifferent lengths from the ends of the expandable section. For example,varying the lengths of adjacent slots can diffuse strain on theexpandable section.

FIGS. 41 through 45 illustrate dimensions of the expandable section(dimensions are shown on attachment B).

FIG. 41 illustrates that the unexpandable section can be integral with acenter shaft and the distal end.

FIG. 43 illustrates that the distal end can have the shaft deploymenttool attachment therethrough.

FIG. 46 illustrates a close up of the distal end of the unexpandablesection, center shaft and distal end.

FIGS. 47 a and 47 b illustrate that the distal cap end can have a capball and a cap sleeve. The cap ball and/or cap sleeve can have internalcap thread along all or part of the length.

FIGS. 48 through 51 illustrate dimensions of the expandable section(dimensions are shown on attachment C).

FIG. 52 illustrates that the expandable attachment device can bereleasably attached to the deployment tool. The deployment tool can havedeployment engagement teeth that can align and intersect with the distalend cap, for example at the cap deployment tool attachments.

FIG. 53 illustrates that the expandable attachment device can bedissembled in separate elements. For example, the unexpandable sectioncan be integral with the center shaft. The center shaft, for example atthe distal end, can have shaft cap attachments that can attach to thedistal end cap.

FIG. 54 illustrates that the expandable attachment device can beassembled by translating the expandable section over the center shaft,as shown by arrow. The distal end cap can then be rotated, as shown byarrow, onto the shaft cap attachments.

FIGS. 55 and 56 illustrate that the deployment tool can have a post tooland a tooth tool. The tooth tool can be separate, attached, or integralwith the post tool.

The post tool can have a post tool hand. The post tool handle can beattached to or integral with a deployment engagement post. The post toolcan have a deployment tool suspension. The deployment engagement postcan be configured to attach to the shaft deployment tool attachment.

The tooth tool can have deployment engagement teeth. The deploymentengagement teeth can be configured to attach to the cap deployment toolattachment. The tooth tool can have a tooth tool handle, for exampleextending radially from the remainder of the tooth tool.

The deployment tool suspension can resiliently separate the tooth tooland the post tool. The deployment tool suspension can suspend thedeployment engagement post from the post tool handle.

FIG. 57 illustrates the expandable section in a radially expandedconfiguration can have an outer diameter 104 from about 7 mm (0.3 in.)to about 15 mm (0.59 in.), for example about 9.99 mm (0.393 in.) orabout 9.31 mm (0.367 in.).

FIGS. 58 and 59 illustrate that an external wedge can be inserted, asshown by arrow in FIG. 58, into the expandable section. The expandablesection can then radially expand, as shown by arrows in FIG. 59. Theexternal wedge can be left in the expandable section or removed from theexpandable section. The wedge can have a transverse cross section thatis square, round (e.g., a conical wedge), rectangular, oval, orcombinations thereof.

FIG. 60 illustrates that the expandable attachment device can have afirst external wedge and a second external wedge. The second externalwedge can be attached to or integral with the unexpanded section and/orotherwise positioned between the expandable section and the unexpandedsection when the expandable section is in a radially contractedconfiguration. The second external wedge can be pointing narrowend-first toward the distal end of the expandable attachment device.

A proximally-directed force can be applied, as shown by arrow, to thefirst external wedge and/or the distal end. The expandable section canthen radially expand, as shown by arrows in FIG. 61, as the wedges arepushed into a channel in the expandable section.

FIG. 62 illustrates that the expandable attachment device can have afirst expandable section, second expandable section, and thirdexpandable section. The expandable sections can each have one or twoexternal wedges entering into an inner hollow or channel, as shown inFIGS. 58 through 61.

FIG. 63 illustrates that the expandable section can have one or moreexpansion elements configured to radially expand. The expandable sectioncan have one, two or more internal wedges. The expansion elements canhave ramps configured to slidably engage the internal wedge when theinternal wedge is compressed into the expansion elements.

FIG. 64 illustrates that the internal wedges can be compressed, as shownby arrows, into the expansion elements. The expansion elements can thenradially expand, as shown by arrows.

FIG. 65 illustrates that the internal wedges can interference fit withthe ramps. As the internal wedges are further compressed, the internalwedges can cause a deformation or other translation of the expansionelements.

FIGS. 66 and 67 illustrates that the expandable section can have a topwall and a bottom wall connected by two side walls. The top wall andbottom wall can have expandable thread. The side wall can haveexpandable thread. The top wall and/or bottom wall can have one or moreramps extending inwardly into the longitudinal channel of the expandablesection.

FIG. 68 illustrates that in a radially expanded configuration, the topwall and bottom wall can translate radially outward, as shown by arrows.The side walls can deform and/or translate radially inward.

FIG. 69 illustrates that the top wall and/or bottom wall can have amanipulation channel passing completely or partially therethrough in asubstantially longitudinal direction. The manipulation channels can be,for example, cylindrical.

FIG. 70 illustrates that the top wall and/or the bottom wall can havelongitudinal guide slots 124. The guide slots 124 can be in fluidcommunication with the longitudinal channel. The guide slots 124 can beparallel with the ramps.

FIGS. 71 and 72 illustrate that a first wedge and a second wedge can beinserted into the longitudinal channel of the expandable section. Thesecond wedge and/or first wedge can be integral with the deployment rod.The first wedge can have a longitudinal wedge channel. The deploymentrod can slidably attach to the first wedge through the wedge channel.The first wedge and second wedge can have configurations thatsubstantially match the respective ramps.

FIG. 73 illustrates that the opposing compressive first and secondtranslational forces can be applied to the first wedge and thedeployment rod, respectively. The first and second wedges can bedeformably translated into the expandable section.

FIG. 74 illustrates that the expandable section can radially expand, forexample near the ends of the expandable section and/or to the length thewedges are inserted.

FIG. 75 illustrates that the expandable section and wedges can beconfigured to radially expand on only one side. For example, the wedgescan have angled slopes on one side of the wedge and flat sides on theopposing side of the angled slopes. The expandable section can have awall with tapered thickness on the side to be radially expanded, and aconstant thickness wall, and/or a thicker wall than the tapered wall, onthe side opposite the tapered wall.

FIG. 76 illustrates that the wedge can have a wedge rail. The wedge railcan align with and insert into the guide slot 124. FIGS. 77 and 78illustrate that the wedge rail can slidably attach to the guide slot124.

FIGS. 79 a through 79 d illustrate that a manipulation tool can have abase, a first leg extending from the base, and a second leg extendingfrom the base. The legs can be configured to fit into the manipulationchannels of the expandable section. The legs can be used to insert intothe manipulation channels and manipulate (e.g., translation, rotation,deformation) the expandable section. Legs can articulate with respect tothe base. The leg articulation can be controlled by controls (not shown)on the base, such as a handle or trigger.

FIG. 80 illustrates that a cone or mandrel can be translated into thelongitudinal channel of an expandable section having struts and joints.The expandable section can have no hoops. The expandable section canhave an anvil at the opposite end of the cone.

FIG. 81 illustrates that the cone can be forced toward the anvil, and/orthe anvil can be forced toward the cone, resulting in longitudinaltranslation of the cone towards the anvil, through the longitudinalchannel. The expandable section over the cone, for example at the distalend, can radially expand, as shown by arrows.

FIG. 82 illustrates that the cone can be longitudinally translated alongthe entire length of the expandable section. The cone can be received inthe anvil. The entire length of the expandable section can radiallyexpand, as shown by arrows. The expansion can be resilient and/ordeformable. The cone can be removed or left in place.

FIG. 83 illustrates that the expandable section can have plates that canbe integral with or attached to the joints and/or struts. The plates canbe configured to be flexibly attached to or integral with the remainderof the expandable section. Each plate can be configured to substantiallycover each port.

FIG. 84 illustrates that a first plate and a second plate can cover aport. The first plate can extend from a first joint adjacent to theport. The second plate can extend from a joint opposite to the firstplate.

FIGS. 85 through 87 illustrate an expandable attachment device that canhave an expandable section that can have a first expandable elementdirectly or indirectly slidably attached to a second expandable element.For example, the first expandable element can be slidably attached tothe center shaft to translate up when the center shaft is translateddistally, and the second expandable element can be slidably attached tothe center shaft to translate down when the center shaft is translateddistally. When the expandable attachment device is in a radiallycontracted configuration, the center shaft can be substantially insidethe expandable element. When the expandable attachment device is in aradially expanded configuration, the center shaft can be substantiallyoutside the expandable element.

The first expandable element can have the tip. The tip can be pointedand/or flat. The first expandable element can have thread on a top side.The first expandable element can have a peg (shown in FIG. 87) that canextend radially inward. The peg can be configured to slide in a firsttrack on the side of the central shaft. The first track can extend frombeing low distally to high proximally.

The second expandable element can have thread on a bottom side. Thefirst expandable element can have a peg that can extend radially inwardsimilar to that of the first expandable element. The peg can beconfigured to slide in a second track on the side of the central shaftopposite the side of the first track. The first track can extend frombeing high distally to low proximally.

FIG. 88 illustrates that when the expandable attachment device is in aradially expanded configuration, the first expandable element can beseparated from the second element.

As the central shaft is withdrawn from the expandable section, the pegof the first expandable element can be forced upward, forcing the firstexpandable element upward. As the central shaft is withdrawn from theexpandable section, the peg of the first expandable element can beforced upward, as shown by arrow in FIG. 88, forcing the secondexpandable element downward.

As the central shaft is withdrawn from the expandable section, the pegof the second expandable element can be forced downward, forcing thesecond expandable element upward, as shown by arrow in FIG. 88.

FIG. 94 illustrates that the expandable element devices can besubstantially triangular from a lateral perspective. The expandableelements can be slidably attached to each other. The expandableattachment device can have multiple expandable elements. A compressiveforce, for example including a proximally directed force applied to thedistal end (as shown by arrow) and/or the distal expandable element, canforce the expandable elements to radially expand, as shown by arrows.

FIG. 95 illustrates that the distal end of the expandable attachmentdevice, for example the tip, can have a transverse cross-section thatcan be round, circular, oval, square, rectangular, triangular, orcombinations thereof. The expandable section can have a transversecross-section that can be round, circular, oval, square, rectangular,triangular, or combinations thereof FIG. 96 illustrates a variation ofthe expandable section.

FIG. 97 illustrates that the expandable section in the radiallycontracted configuration can have a straight expandable section axes.FIG. 98 illustrates that the expandable section in a radially expandedconfiguration can have a straight or curved expandable section axis,and/or that the expandable section axis can be at an angle with respectto the expandable section axis in the radially contracted configuration.

FIGS. 99 and 100 illustrates that the expandable section can have aseries of expandable elements having a slidably attached center shafttherethrough. The center shaft can have a center shaft anchor. Thecenter shaft anchor can have a larger diameter than the diameter of thelongitudinal channel. Teeth can radially extend from the expandableelements, for example from at least opposite sides of alternatingexpandable elements, as shown.

FIGS. 101 and 102 illustrate that the expandable elements can have guiderails. The guide rails can slidably attach to receiving elements onadjacent expandable elements. The longitudinal channel in at least everyother expandable element can be elongated in the transverse direction.

FIGS. 103 and 104 illustrate that the expanding element can have one ortwo guide rails on each surface adjacent to another expanding elementwhen assembles. The cross-section of the longitudinal channel in anindividual expanding element can be, for example, circular, oval,square, rectangular, or combinations thereof.

FIG. 105 illustrates that the expandable element can have one, two ormore guide grooves on each surface adjacent to another expanding elementwhen assembled. The guide grooves can be configured to slidably attachto the guide rails.

FIG. 106 illustrates that the expandable element can have one or morecontouring channels. The contouring channels can be a defined,substantially closed volume within the expandable element. Thecontouring channels can deform, for example, due to force appliedagainst the teeth during use. When deformed, the contouring channel can,for example, reduce the stress applied on the neighboring tissue whenimplanted compared to the expandable element in a non-deformedconfiguration.

FIG. 107 illustrates an expandable element having a number of contouringchannel extending radially away from the expandable element channel. Thecontouring channels can be configured as slots open to the outside ofthe expandable element.

FIG. 108 illustrates that the distal end cap can be distal to the mostdistal expandable element. For example, the distal end cap can be, or beattached to, the center shaft anchor.

FIG. 109 illustrates that a longitudinally compressive force, as shownby arrow, can be delivered through the distal end cap. The expandableelements can then radially expand, as shown by arrows.

FIGS. 110 and 111 illustrate the expandable section having nine and fiveexpandable elements, respectively.

FIGS. 112 and 113 illustrates that the center shaft can be configured tohave one or more alternately oppositely facing integral wedges. Theexpandable section can have one or more expandable elements. Theexpandable elements can have guide rails on the proximal ends and guidegrooves on the distal ends. The guide grooves and guide rails canconstrain relative motion between the expandable elements to a singledegree of freedom (e.g., lateral motion). The internal surfaces of theexpandable elements can have alternately oppositely facing internalramps that can be configured to abut the integral wedges.

FIG. 113 illustrates that the center shaft can be translated relative tothe expandable section, for example with the center shaft beingtranslated out of the expandable section. The expandable elements canthen radial expand in opposite directions as the adjacent expandableelements, as shown by arrows.

FIG. 114 illustrates that the expandable element can have one or twoguide grooves in the distal end of the expandable element. The guidegrooves can be notches in the wall around the longitudinal channel. Theexpandable element can have one or two guide rails at the proximal endof the expandable element. The guide rails can be configured to slidablyattach to the guide grooves when one expandable element in stacked onanother expandable element.

FIG. 115 illustrates that the internal ramp can be a slope on theinternal surface of the longitudinal channel. The thread can be oil asingle side of the expandable element.

FIGS. 116 and 117 illustrate that when the integral wedges of the centershaft press into the internal ramps of the expandable elements, as shownby arrows in FIG. 117, the expandable elements can be pushed radiallyoutward by the integral wedges, as shown by arrows.

FIG. 118 illustrates that the expandable section can have first, second,third and more expandable elements that can be cams or otheroffset-rotation elements. FIG. 119 illustrates that the distal end canbe rotated, as shown by arrow. The expandable elements can then radiallytranslate or expand, as shown by arrows. The expandable elements cantranslate at different timings, so that the

FIG. 120 a illustrates that the expandable elements can have a centershaft extending through the expandable elements. The center shaft can beoffset from the center of area of the expandable element in the planetransverse to the expandable attachment device axis.

FIG. 120 b illustrates that the expandable section in a radiallycontracted configuration can have all of the expandable elementssubstantially aligned along the expandable attachment device axis.

FIG. 120 c illustrates that the expandable section can be radiallyexpanded by rotating the center shaft and/or rotating the expandableelements around the center shaft. The cam expandable elements can splayand radially expand.

FIG. 121 illustrates that the expandable attachment device can havemultiple expandable elements eccentrically attached to a center shaft,and/or with lobed configurations.

FIGS. 122 through 124 illustrate that the expandable attachment devicecan have one through four expandable elements eccentrically attached toa center shaft (not shown). The expandable elements can have teethradially extending from the expandable elements.

FIGS. 125 through 127 illustrate the expandable attachment device witheccentrically attached expandable elements in a radially expandedconfiguration.

FIGS. 128 and 129 illustrate that the expandable section can have afirst, second and third expandable element. The expandable elements canbe slidably attached by interlocking rails and tracks. The rails andtracks can constrain relative motion between adjacent expandableelements to one degree of freedom (e.g., vertical relative motion).

The expandable elements can have longitudinal channels configured, forexample as shown, to receive a multi-lobed center shaft and becontrollable as shown in FIGS. 128 through 133. The configuration of thelongitudinal channel in each expandable element can be the same ordifferent as the other expandable elements. For example, the firstexpandable element and the third expandable element can havesubstantially identically configured longitudinal channels. The secondexpandable element can have a longitudinal channel configured to be ahorizontally reversed configuration of the longitudinal channel of thefirst expandable element. The second expandable element can have alongitudinal channel configured to be-about a 180° rotation of thelongitudinal channel of the first expandable element. The center shaftcan have a first lobe and a second lobe.

FIGS. 130 and 131 illustrate that the center shaft can be rotated, asshown by arrow. When the center shaft is rotated, the lobes can exertforces against the expandable elements. The expandable elements can betranslated in a direction substantially perpendicular to thelongitudinal axis of the center shaft. For example, the first and thirdexpandable elements can translate toward the up, as shown by arrows. Thesecond expandable element can translate down, as shown by arrows.

FIGS. 132 and 133 illustrates that the center shaft can be rotated inthe opposite direction as shown in FIGS. 130 and 131. The expandableelements can translate in the opposite direction as shown from FIG. 131.

FIGS. 134 and 135 illustrate a center shaft that can have alternatingfirst lobes and second lobes along the length of the center shaft. Thefirst lobes can have a first lobe axis. The second lobes can have asecond lobe axis. When viewed in the same plane, the angle between thefirst lobe axis and the second lobe axis can be a lobe angle. The lobeangle can be from about 90° to about 180°. The first lobes can beactuated in an opposite rotational direction than the second lobes.

FIG. 136 illustrates an expandable section that can have a firstexpandable element that can translate in the opposite direction of thesecond expandable element when the center shaft is rotated. The firstexpandable element can have first element teeth. The second expandableelement can have second element teeth. The element teeth can extendradially inward in the longitudinal channel. The first element teeth canbe on the opposite side of the longitudinal channel as the secondelement teeth. The center shaft can have gear teeth extending radiallyoutward. The gear teeth can engage the first element teeth can thesecond element teeth.

FIGS. 137 through 139 illustrate that when the center shaft is rotated,the first expandable element can translate up at the same rate that thesecond expandable element can translate down.

FIG. 140 illustrates an expandable section that can have thread or teethon one, two, three or more spines extending radially from the wall ofthe expandable section. In a radially contracted configuration, the wallcan have multiple folds, for example two folds between each two adjacentspines. The folds can be unevenly spaced between the adjacent spines.

FIG. 141 illustrates that the wall can have two folds between each twoadjacent spines. The folds can be evenly spaced between the adjacentspines.

FIG. 142 illustrates that the walls can have one fold between adjacentspines. The spines can extend radially inward and/or outward from thewall.

FIGS. 143 and 144 illustrate that the expandable section (shown forexemplary purposes as the expandable section of FIG. 141) can be loadedon the center shaft of an expandable attachment device. The expandablesection can be placed between a first cone and a second cone on theexpandable attachment device. The expandable attachment device can havea mandrel. The second cone can be part of the mandrel.

FIG. 145 illustrates that the mandrel can be pushed, as shown by arrow,toward the expandable section. The expandable section can radiallyexpand as shown by arrow.

The distal end can be configured to attach to a separate device, such asa fixation rod or plate. The distal end can be threaded.

FIG. 146 illustrates that the expandable attachment device can have afirst expandable section and a second expandable section. Eachexpandable section can be between a first cone and a second cone, andcan be radially expanded as described herein, including as shown in FIG.145.

FIGS. 147 through 149 illustrate the expandable sections of FIGS. 140through 142, respectively, loaded on the center shaft of the expandableattachment device.

FIGS. 150 and 153 illustrate that the expandable section can have aboutfour angled ports. Each port can have a joint. Between two adjacentports can be an individual expandable segment, for example the firstexpandable segment and the second expandable segment, as shown.

FIG. 152 illustrates that a longitudinally compressive force, as shownby arrows, can be applied to the expandable section. The expandablesegments can rotate, as shown by arrows, around the adjacent joints. Theports can close. In the radially expanded configuration, the expandablesection can have a distal end shifted laterally from the proximal end.

FIG. 153 illustrates that the expandable section can have larger portsand/or the expandable section cali be over compressed, causingdeformation after the ports have closed. The distal end and the proximalend of the expandable section can be laterally aligned.

FIG. 154 illustrates a side view of a spine. FIG. 155 illustrates thatharder, cortical bone surrounds softer, cancellous bone in the vertebra.

FIG. 156 illustrates that the expandable attachment device can betranslated and/or rotated into the pedicle and/or into the vertebralbody. The expanded section can be positioned in the cortical bone.

FIGS. 157 and 158 illustrate that the expandable section can be radiallyexpanded, for example in the cancellous bone of the pedicle and/or thevertebral body. The radius of the radially expanded section can belarger than the entry hole created to insert the attachment device intothe vertebra.

The distal end can extend from the bone. A separate device, such as afixation rod or plate, can be attached to the distal end.

FIG. 159 illustrates that an expandable attachment device can be used totreat a long bone break, such as in the femur or humerus. The expandableattachment device can be inserted into the cancellous and/or corticalpart of the bone. The expandable attachment device can be positioned tohave a first expandable section on a first side of the bone fracture.The expandable attachment device can be positioned to have a secondexpandable section on a second side of the bone fracture. The expandableattachment device can have an unexpandable section between the first andsecond expandable sections. The unexpandable section can be positionedacross the bone fracture.

FIG. 160 illustrates that a first expandable attachment device 22 a canbe placed in a first section of the bone (e.g., the femur head). Asecond expandable attachment device 22 b can be placed in a secondsection of the bone. The second expandable attachment device 22 b canhave a collar configured to fixedly receive the unexpandable section ofthe first expandable attachment device. The unexpandable section of thefirst expandable attachment device 22 a can be fixedly attached to thecollar.

FIGS. 161 and 162 illustrates that the expandable attachment device canhave an end attachment configured to be attached, as shown by arrow, tothe distal end. For example, the expandable attachment device can bepositioned in a bone and radially expanded. The end attachment can beattached to the distal end, as shown in FIG. 164. The end attachment canbe configured to attach to a separate device, such as a fixation rod orplate, as shown in FIG. 163.

FIG. 165 through 166 illustrates that the expandable attachment devicecan be deployed by radially expanding the first expandable section at afirst end, and concurrently or subsequently, radially expanding, thesecond expandable section at a second end.

FIGS. 168 and 169 illustrate that the expandable attachment device canbe positioned so the first expandable section can be radially expandedin the pedicle or vertebral body. The second expandable section can beradially expanded in the pedicle, vertebral body, or outside the bone,for example in the soft tissue or in a virtual space. A separate device,such as a fixation rod or plate can be attached to the second expandablesection.

FIGS. 170 through 172 illustrate that a fixation plate can be attachedto the anterior side of the spine. FIG. 171 illustrates that theexpandable attachment devices can be attached to the fixation plate andthe first expandable section can be radially expanded. FIG. 172illustrates that the second expandable sections of the expandableattachment devices can be positioned in the cancellous bone. The secondexpandable sections can be radially expanded, as shown by arrows, in thecancellous bone, for example in the vertebral body.

FIG. 173 illustrates that the deployment tool can have a first handlerotatably attached to a second handle. Rotating the first handle and thesecond handle towards each other, as shown by arrows, can result inlongitudinal compression of the expandable section of the expandableattachment device. See the incorporated applications for additionalelements of the deployment tool. The expandable attachment device can beremovably attached to the deployment head.

FIG. 174 illustrates that an oral space can have a missing tooth. Themissing tooth can be surrounded on one side, both sides or neither side,by teeth. The gum, bone, and teeth roots are also shown.

FIG. 175 illustrates that the expandable attachment device can bescrewed (e.g., rotation and translation), as shown by arrows, into themissing tooth space in the bone. The unexpandable thread can compact orcut bone as the expandable attachment device is inserted into themissing tooth space in the bone. FIG. 176 illustrates that theexpandable support device can be fully inserted into the bone. Thedistal end can extend above the gum.

FIG. 177 illustrates that the expandable section can be radiallyexpanded, as shown by arrows, for example with the expandable supportdevice fully inserted into the bone.

FIG. 178 illustrates that a replacement tooth can be fixedly orremovably attached to the distal end. The distal end can be configuredto attach to the replacement tooth (e.g., thread, one or more latches,clasps, locks). The replacement tooth can be positioned between theadjacent teeth. The space between the replacement tooth and the gum canbe partially or completely filled by a filler, for example abiocompatible cement (e.g., a bone cement).

FIG. 179 illustrates that the expandable attachment device can haveunidirectional and/or one-way teeth along all or part of the length ofthe expandable section. The expandable section can be alongsubstantially the entire length of the expandable attachment device, forexample, except for the distal end configured to attach to thereplacement tooth.

FIG. 180 illustrates that the expandable section can be radiallyexpanded, as shown by arrows. The replacement tooth can then be attachedas shown in FIG. 178.

FIGS. 181 and 182 illustrate that the expandable section can haveexpandable threads around one or more sections of the expandable section(e.g., for example on opposite sides of the expandable section, asshown). The distal wedge and/or the proximal wedge can have threads onthe internal diameter or be threadless on the internal diameter. Theinternal threads can engage the proximal length of the center shaft(e.g., the proximal length of the center shaft have a smaller, larger orthe same diameter as compared to the diameter of the distal length ofthe center shaft). The proximal wedge can have an internal diameter thatcan be larger than the threads on the center shaft so the proximal wedgecan slide freely over the distal length of the center shaft and/or theproximal length of the center shaft.

FIGS. 183 and 184 illustrate that the outer diameter of the unexpandablesection can be substantially equivalent to the outer diameters of theexpandable section (e.g., in a radially contracted configuration) and/orthe wedges. The outer diameter of the expandable section (e.g., in aradially contracted configuration) can be slightly larger than, smallerthan, or substantially equivalent to the outer diameter of theunexpandable section.

The internal diameter of the expandable section and the internaldiameter of one or more of the wedges (e.g., shown as only the proximalwedge in FIGS. 183 and 184) can have internal threads and/or teeth, forexample, configured to engage threads and/or teeth on the center shaft.

The center shaft can have a reduced diameter (as shown) at a length nearthe longitudinal middle of the center shaft. The internal threads orteeth (e.g., on the inner diameter of the expandable section) might notengage the center shaft along the length having the reduced diameter,for example because of no geometric overlap and/or the absence of teethor threads along the outer diameter of the center shaft along the lengthhaving the reduced diameter.

FIGS. 185, 186 and 187 illustrate that the wedges can be segmented. Forexample, the proximal wedge can have adjacent and/or attached proximalwedge first and second segments. The distal wedge can have adjacentand/or attached distal wedge first and second segments.

The wedge segments can be configured to individually or jointedlyfixedly (e.g., via ratcheting on the center shaft and/or wedge) orreleasably attach to the center shaft and/or expandable section. Forexample, the expandable section and/or center shaft can have one or moremale or female configurations (e.g., guide slots 124, such as T-slots,as shown) and the wedge segment can have one or more correspondingfemale or male segments (e.g., wedge rails, such as T-extensions, asshown). When the proximal wedge is forced distally and/or the distalwedge is forced proximally, one or both wedges can force the expandablesection to radially expand. When the proximal wedge is forced proximallyand/or the distal wedge is forced distally, one or both wedges can forcethe expandable section to radially contract.

Any or all elements of the expandable attachment device and/or otherdevices or apparatuses described herein can be made from, for example, asingle or multiple stainless steel alloys, nickel titanium alloys (e.g.,Nitinol), cobalt-chrome alloys (e.g., ELGILOY® from Elgin SpecialtyMetals, Elgin, Ill.; CONICHROME® from Carpenter Metals Corp.,Wyomissing, Pa.), nickel-cobalt alloys (e.g., MP35N® from MagellanIndustrial Trading Company, Inc., Westport, Conn.), molybdenum alloys(e.g., molybdenum TZM alloy, for example as disclosed in InternationalPub. No. WO 03/082363 A2, published 9 Oct. 2003, which is hereinincorporated by reference in its entirety), tungsten-rhenium alloys, forexample, as disclosed in International Pub. No. WO 03/082363, polymerssuch as polyethylene teraphathalate (PET), polyester (e.g., DACRON® fromE. I. Du Pont de Nemours and Company, Wilmington, Del.), poly esteramide (PEA), polypropylene, aromatic polyesters, such as liquid crystalpolymers (e.g., Vectran, from Kuraray Co., Ltd., Tokyo, Japan), ultrahigh molecular weight polyethylene (i.e., extended chain, high-modulusor high-performance polyethylene) fiber and/or yarn (e.g., SPECTRA®Fiber and SPECTRA® Guard, from Honeywell International, Inc., MorrisTownship, N.J., or DYNEEMA® from Royal DSM N.V., Heerlen, theNetherlands), polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE),polyether ketone (PEK), polyether ether ketone (PEEK), poly ether ketoneketone8 (PEKK) (also poly aryl ether ketone ketone), nylon,polyether-block co-polyamide polymers (e.g., PEBAX® from ATOFINA, Paris,France), aliphatic polyether polyurethanes (e.g., TECOFLEX® fromThermedics Polymer Products, Wilmington, Mass.), polyvinyl chloride(PVC), polyurethane, thermoplastic, fluorinated ethylene propylene(FEP), absorbable or resorbable polymers such as polyglycolic acid(PGA), poly-L-glycolic acid (PLGA), polylactic acid (PLA), poly-L-lacticacid (PLLA), polycaprolactone (PCL), polyethyl acrylate (PEA),polydioxanone (PDS), and pseudo-polyamino tyrosine-based acids, extrudedcollagen, silicone, zinc, echogenic, radioactive, radiopaque materials,a biomaterial (e.g., cadaver tissue, collagen, allograft, autograft,xenograft, bone cement, morselized bone, osteogenic powder, beads ofbone) any of the other materials listed herein or combinations thereof.Examples of radiopaque materials are barium sulfate, zinc oxide,titanium, stainless steel, nickel-titanium alloys, tantalum and gold.

Any or all elements of the expandable attachment device and/or otherdevices or apparatuses described herein, can be, have, and/or becompletely or partially coated with agents and/or a matrix a matrix forcell ingrowth or used with a fabric, for example a covering (not shown)that acts as a matrix for cell ingrowth. The matrix and/or fabric canbe, for example, polyester (e.g., DACRON® from E. I. Du Pont de Nemoursand Company, Wilmington, Del.), poly ester amide (PEA), polypropylene,PTFE, ePTFE, nylon, extruded collagen, silicone, any other materialdisclosed herein, or combinations thereof.

The expandable attachment device and/or elements of the expandableattachment device and/or other devices or apparatuses described hereinand/or the fabric can be filled, coated, layered and/or otherwise madewith and/or from cements, fillers, glues, and/or an agent deliverymatrix known to one having ordinary skill in the art and/or atherapeutic and/or diagnostic agent. Any of these cements and/or fillersand/or glues can be osteogenic and osteoinductive growth factors.

Examples of such cements and/or fillers includes bone chips,demineralized bone matrix (DBM), calcium sulfate, corallinehydroxyapatite, biocoral, tricalcium phosphate, calcium phosphate,polymethyl methacrylate (PMMA), biodegradable ceramics, bioactiveglasses, hyaluronic acid, lactoferrin, bone morphogenic proteins (BMPs)such as recombinant human bone morphogenetic proteins (rhBMPs), othermaterials described herein, or combinations thereof.

The agents within these matrices can include any agent disclosed hereinor combinations thereof, including radioactive materials; radiopaquematerials; cytogenic agents; cytotoxic agents; cytostatic agents;thrombogenic agents, for example polyurethane, cellulose acetate polymermixed with bismuth trioxide, and ethylene vinyl alcohol; lubricious,hydrophilic materials; phosphor cholene; anti-inflammatory agents, forexample non-steroidal anti-inflammatories (NSAIDs) such ascyclooxygenase-1 (COX-1) inhibitors (e.g., acetylsalicylic acid, forexample ASPIRIN® from Bayer AG, Leverkusen, Germany; ibuprofen, forexample ADVIL® from Wyeth, Collegeville, Pa.; indomethacin; mefenamicacid), COX-2 inhibitors (e.g., VIOXX® from Merck & Co., Inc., WhitehouseStation, N.J.; CELEBREX® from Pharmacia Corp., Peapack, N.J.; COX-1inhibitors); immunosuppressive agents, for example Sirolimus (RAPAMUNE®,from Wyeth, Collegeville, Pa.), or matrix metalloproteinase (MMP)inhibitors (e.g., tetracycline and tetracycline derivatives) that actearly within the pathways of an inflammatory response. Examples of otheragents are provided in Walton et al, Inhibition of Prostoglandin E₂Synthesis in Abdominal Aortic Aneurysms, Circulation, Jul. 6, 1999,48-54; Tambiah et al, Provocation of Experimental Aortic InflammationMediators and Chlamydia Pneumoniae, Brit. J. Surgery 88 (7), 935-940;Franklin et al, Uptake of Tetracycline by Aortic Aneurysm Wall and ItsEffect on Inflammation and Proteolysis, Brit. J. Surgery 86 (6),771-775; Xu et al, Sp1 Increases Expression of Cyclooxygenase-2 inHypoxic Vascular Endothelium, J. Biological Chemistry 275 (32)24583-24589; and Pyo et al, Targeted Gene Disruption of MatrixMetalloproteinase-9 (Gelatinase B) Suppresses Development ofExperimental Abdominal Aortic Aneurysms, J. Clinical Investigation 105(11), 1641-1649 which are all incorporated by reference in theirentireties.

Other examples of fractures types that can be treated with the discloseddevice and method include Greenstick fractures, transverse fractures,fractures across growth plates, simple fractures, wedge fractures,complex fractures, compound fractures, complete fractures, incompletefractures, linear fractures, spiral fractures, transverse fractures,oblique fractures, comminuted fractures, impacted fractures, and softtissue tears, separations (e.g., avulsion fracture), sprains, andcombinations thereof. Plastic deformations of bones can also be treatedwith the disclosed device and method.

Other examples of bones that can be treated with the disclosed deviceand method include the fingers (e.g., phalanges), hands (e.g.,metacarpals, carpus), toes (e.g., tarsals), feet (metatarsals, tarsus),legs (e.g., femur, tibia, fibula), arms (e.g., humerus, radius, ulna),scapula, coccyx, pelvis, clavicle, scapula, patella, sternum, ribs, orcombinations thereof.

Devices, elements and configurations disclosed as expandable supportdevices in the following applications can be used for the expandablesection in the present application, and the following applications areincorporated by reference herein in their entireties: PCT ApplicationNo. 2005/034115 filed 21 Sep. 2005, PCT Application No. 2006/016553filed 27 Apr. 2006, PCT Application No. 2005/034742 filed 26 Sep. 2005,PCT Application No. 2005/034728 filed 26 Sep. 2005, PCT Application2005/037126 filed 12 Oct. 2005, PCT Application No. 2006/62333 filed 19Dec. 2006, PCT Application No. 2006/038920 filed 4 Oct. 2006, PCTApplication No. 06/027601 filed 14 Jul. 2006, PCT Application No.2006/62201 filed 15 Dec. 2006, PCT Application No. 2006/62339 filed 19Dec. 2006, PCT Application No. 2006/48667 filed 19 Dec. 2006, and U.S.patent application Ser. No. 11/457,772 filed 14 Jul. 2006.

All dimensions shown herein are exemplary. The dimensions shown hereincan at least be expanded to ranges from about 50% to about 150% of theexemplary dimension shown herein, more narrowly from about 75% to about125% of the exemplary dimension shown herein.

The use of the term “radial expansion” herein refers to both avolumetric increase of an element, or an increase in the radialdimension of the element itself, or the increase in the maximum radiusof the element as measured from the expandable attachment device axis.

Any elements described herein as singular can be pluralized (i.e.,anything described as “one” can be more than one). Any species elementof a genus element can have the characteristics or elements of any otherspecies element of that genus. The above-described configurations,elements or complete assemblies and methods and their elements forcarrying out the invention, and variations of aspects of the inventioncan be combined and modified with each other in any combination.

1. An attachment device having a longitudinal axis comprising: aradially expandable length comprising a deformable frame, and whereinthe frame comprises a plurality of struts, and wherein the plurality ofstruts defines a plurality of open cells, and a length configured toattach to a separate device.
 2. The device of claim 1, wherein theradially expandable length is configured to radially expand when theradially expandable length is longitudinally contracted.
 3. The deviceof claim 1, wherein the radially expandable length is configured toradially expand when the radially expandable length is rotated.
 4. Thedevice of claim 1, wherein the radially expandable length is configuredto radially expand when a wedge is translated into the radiallyexpandable length.
 5. The device of claim 1, wherein the attachmentdevice further comprises a radially unexpandable length.
 6. The deviceof claim 1, wherein the radially expandable length comprises a cam. 7.The device of claim 1, wherein the radially expandable length comprisesa ramp configuration.
 8. The device of claim 1, further comprises athreaded length.
 9. The device of claim 8, wherein the threaded lengthis on the opposite side of the radially expandable length from thelength configured to attach to a separate device.
 10. The device ofclaim 9, wherein the threaded length is radially unexpandable.
 11. Thedevice of claim 1, wherein the length configured to attach to a separatedevice has a substantially spherical configuration.
 12. The device ofclaim 1, wherein the length configured to attach to a separate devicehas an interface configured to attach to a removable deployment tool.13. A method for deploying an attachment device having a longitudinalaxis in a bone comprising: inserting the attachment device of claim 1into the bone, radially expanding a radially expandable length of theattachment device.
 14. The method of claim 13, wherein radiallyexpanding comprises radially expanding a radially expandable length ofthe attachment device in a cancellous portion of the bone.
 15. Themethod of claim 13, wherein inserting comprises inserting into avertebral body.
 16. The method of claim 13, wherein radially expandingcomprises longitudinal compressing the attachment device.
 17. The methodof claim 13, wherein radially expanding comprises rotating theattachment device.
 18. The method of claim 13, wherein radiallyexpanding comprises inserting a leverage element into the attachmentdevice.
 19. The method of claim 18, wherein the leverage elementcomprises a wedge.
 20. The method of claim 13, wherein the attachmentdevice comprises a resilient section, and wherein radially expandingcomprises releasing a mechanical constraint from the resilient section.